Provider Demographics
NPI:1306866165
Name:BELLAM, SAMARA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMARA
Middle Name:S
Last Name:BELLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1103 FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2308
Mailing Address - Country:US
Mailing Address - Phone:404-366-5544
Mailing Address - Fax:404-366-5623
Practice Address - Street 1:1103 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2308
Practice Address - Country:US
Practice Address - Phone:404-366-5544
Practice Address - Fax:404-366-5623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0406541OtherUNITED HEALTH CARE
GA303918OtherWELLCARE
GA4534OtherKAISER
GA52235452OtherBLUE CROSS AND BLUE SHIEL
GA00229413-AMedicaid
GA5580082OtherAETNA
GA00229413-AMedicaid